Técnicas malabsortivas en cirugía bariátrica

  1. A. Sánchez-Pernaute 1
  2. A. Torres 1
  3. M. Á. Rubio 1
  4. M. E. Pérez-Aguirre 1
  1. 1 Servicio de Cirugía y Servicio de Endocrinología. Hospital Clínico San Carlos. Madrid.
Aldizkaria:
Cirugía Andaluza

ISSN: 2695-3811,  1130-3212

Argitalpen urtea: 2019

Alea: 30

Zenbakia: 4

Orrialdeak: 471-476

Mota: Artikulua

DOI: 10.37351/2019304.7 DIALNET GOOGLE SCHOLAR lock_openDialnet editor

Beste argitalpen batzuk: Cirugía Andaluza

Garapen Iraunkorreko Helburuak

Laburpena

Introduction: malabsorptive operations were the first bariatric techniques developed. From the initial jejunoileal and jejunocolic bypass, malabsorptive techniques evolved to biliopancreatic diversion and duodenal switch, which offered very good weight loss results with less complications and secondary effects. Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a simplification of the duodenal switch that eliminates one anastomosis, what decreases operative complexity and secondary effects of malabsorption. Patients: from 2007 to 2014, 169 patients were submitted to SADI-S in our Institution. Mean age fo the series was 46 years, mean BMI 46 kg/m2, and 64% of the patients were female. Ninety-seven patients were diabetics, 81 had obstructive sleep apnoea, 91 hypertension and 126 dyslipidemia. SADI-S was performed with a 200 cm common limb in the first 50 patients and with a 250 cm one in the other 119. Results: there was no postoperative mortality. Two patients suffered from anastomotic leakage. Excess weight loss was 92% in the first postoperative year and 89% at 5 years from surgery. Five percent of the patients did not achieve a 50% excess weight loss. Ten patients were re-operated for recurrent hypoproteinemia, 6 had been submitted to SADI-S with a 2 meter common limb and 4 to SADI-S with a 2,5 meter limb. Diabetes remission was 73% at 5 years. Conclusions: SADI-S is a simplified duodenal switch that offers similar results than old malabsorptive techniques with a lower operative complications rate and long-term sequelae.

Erreferentzia bibliografikoak

  • Kremen AJ, Linner JH, Nelson CH. An experimental evaluation of the nutritional importance of proximal and distal small intestine. Ann Surg 1954; 140:439-448.
  • Payne JH, DeWind LT. Surgical treatment of obesity. Am J Surg 1969; 118:141-147.
  • Buchwald H, Varco RL. Partial ileal bypass for hypercholesterolemia and atherosclerosis. Surg Gynecol Obstet 1967; 124:1231-1238.
  • Scopinaro N, Gianetta E, Civalleri D, Bonalumi U, Bachi V. Bilio-pancreatic bypass for obesity: 1. An experimental study in dogs. Br J Surg 1979; 66:613-617.
  • Scopinaro N, Gianetta E, Civalleri D, Bonalumi U, Bachi V. Bilio-pancreatic bypass for obesity: II. Initial experience in . Br J Surgman 1979; 66:618-620.
  • Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004; 292:1724-37.
  • Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, Bantle JP, Sledge I. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 2009;122:248-256.
  • Hess DS, Hess DW. Biliopancreatic diversion with a duodenal switch. Obes Surg 1998;8:267-82.
  • Lagacé M, Marceau P, Marceau S, Hould FS, Potvin M, Bourque RA, Biron S. Biliopancreatic Diversion with a New Type of Gastrectomy: Some Previous Conclusions Revisited. Obes Surg 1995;5:411-418.
  • Wangensteen OH, Varco RL, Hay L, Walpole S, Trach B. Gastric acidity before and after operative procedure with special reference to the role of the pylorus and antrum: a preliminary report of a clinical and experimental study. Ann Surg 1940;112:626-70.
  • Sánchez-Pernaute A, Rubio Herrera MA, Pérez-Aguirre E, García Pérez JC, Cabrerizo L, Díez Valladares L, Fernández C, Talavera P, Torres A. Proximal duodenal-ileal end-to-side bypass with sleeve gastrectomy: proposed technique. Obes Surg 2007;17:1614-8.
  • Rutledge R. The mini-gastric bypass: experience with the first 1,274 cases. Obes Surg 2001;11:276-80.
  • Sánchez-Pernaute A, Herrera MA, Pérez-Aguirre ME, Talavera P, Cabrerizo L, Matía P, Díez-Valladares L, Barabash A, Martín-Antona E, García-Botella A, Garcia-Almenta EM, Torres A. Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). One to three-year follow-up. Obes Surg 2010;20:1720-6.
  • Sánchez-Pernaute A, Rubio MÁ, Pérez Aguirre E, Barabash A, Cabrerizo L, Torres A. Single-anastomosis duodenoileal bypass with sleeve gastrectomy: metabolic improvement and weight loss in first 100 patients. Surg Obes Relat Dis 201;9:731-5.
  • Mitzman B, Cottam D, Goriparthi R, Cottam S, Zaveri H, Surve A, Roslin MS. Stomach Intestinal Pylorus Sparing (SIPS) Surgery for Morbid Obesity: Retrospective Analyses of Our Preliminary Experience. Obes Surg 2016;26:2098-2104.
  • Sánchez-Pernaute A, Pérez-Aguirre E, Díez-Valladares L, Robin A, Talavera P, Rubio MA, Torres García A. "Right-angled" stapled latero-lateral duodenojejunal anastomosis in the duodenal switch. Obes Surg 2005;15:700-2.
  • Scopinaro N. Biliopancreatic diversion: mechanisms of action and long-term results. Obes Surg 2006;16:683-9.
  • Hess DS, Hess DW, Oakley RS. The biliopancreatic diversion with the duodenal switch: results beyond 10 years. Obes Surg 2005; 15:408-416.
  • Pereira SS, Guimarães M, Almeida R, Pereira AM, Lobato CB, Hartmann B, Hilsted L, Holst JJ, Nora M, Monteiro MP. Biliopancreatic diversion with duodenal switch (BPD-DS) and single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) result in distinct post-prandial hormone profiles. Int J Obes 2018; doi: 10.1038/s41366-018-0282-z. [Epub ahead of print]
  • Regan JP, Inabnet WB, Gagner M, Pomp A. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg 2003;13:861-4.
  • DeMaria EJ, Murr M, Byrne TK, Blackstone R, Grant JP, Budak A, Wolfe L. Validation of the obesity surgery mortality risk score in a multicenter study proves it stratifies mortality risk in patients undergoing gastric bypass for morbid obesity. Ann Surg 2007;246:578-82.
  • Higa KD, Ho T, Boone KB. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention.
Datuen iturria: Dialnet